Use of an rxr agonist and taxanes in treating her2+ cancers

ABSTRACT

The present specification provides improved methods of treating Her2+ cancers in which an RXR agonist and a taxane are administered to a subject having a Her2+ cancer. Thyroid hormone and other anticancer agents may also be administered. Related compositions and combination are also disclosed

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of U.S. Provisional Pat. Application 63/286,986, filed Dec. 7, 2021, the entire contents of which are incorporated by reference herein.

FIELD

The present application is related to methods of treating Her2+ cancers with combinations of RXR agonists and taxanes.

STATEMENT REGARDING FEDERALLY-SPONSORED RESEARCH

This invention was made with government support under grant number HHSN261201500018l awarded by the National Institutes of Health. The government has certain rights in the invention.

BACKGROUND

Compounds which have retinoid-like biological activity are well known in the art and are described in numerous United States Patents including, but not limited to, U.S. Pat. Nos. 5,466,861; 5,675,033 and 5,917,082, all of which are herein incorporated by reference. Preclinical studies suggest that selective activation of Retinoid X Receptors (RXR), which modulate functions associated with differentiation, inhibition of cell growth, apoptosis and metastasis, with RXR-acting agents (rexinoids) may be useful in treating a variety of diseases associated with the biochemical functions modulated by RXR.

For example, TARGRETIN® (bexarotene), which is a retinoid X receptor (RXR) agonist having retinoic acid receptor (RAR) agonist activity as well, was approved by the U.S. Food and Drug Administration for the treatment, both oral and topical, of cutaneous manifestations of cutaneous T cell lymphoma in patients who are refractory to at least one prior systemic therapy. Encouraging results were obtained with TARGRETIN® in several Phase || studies in NSCLC (non-small cell lung cancer). However, the pivotal Phase III clinical study did not show increased survival. One possible explanation for the limited success of bexarotene is that its activation of RAR decreases its efficacy as an anticancer agent. Thus, more selective RXR agonists may hold greater promise.

Treatments for cancer are ever evolving, gaining in specificity and sophistication. Early non-surgical cancer treatments generally targeted rapidly dividing cells which were more sensitive to radiological and chemical assault. Over time, more specific and less generally toxic treatments have been developed. Some treatments appear to have broad applicability, for example immune checkpoint inhibitors or rexinoids. Others are targeted to cancers that express a particular antigen or other biomarker involved in the regulation of proliferation or differentiation; including many monoclonal antibodies and kinase inhibitors. There is also still a role for cytotoxic agents in cancer treatment. Yet as the variety of cancer treatments has grown, it has become ever harder to determine which treatments might be productively combined and for what indications.

SUMMARY

Herein disclosed are improved methods of treatment of Her2⁺ cancers comprising treating a patient having a Her2⁺ tumor with a combination of a taxane and a RXR agonist capable of inhibiting cancer growth. In some embodiments, the treatment combination further comprises thyroid hormone.

One aspect is a method of treating a patient with Her2⁺ cancer comprising administering a RXR agonist of Formula I,

-   wherein R is H, or lower alkyl of 1 to 6 carbons, or a     pharmaceutically-acceptable salt thereof, to the patient, -   wherein the patient has received, is receiving, or is scheduled to     receive a taxane.

One aspect is a method of treating a patient with Her2+ cancer comprising administering a RXR agonist of Formula I,

wherein R is H, or lower alkyl of 1 to 6 carbons, or a pharmaceutically-acceptable salt thereof, and a taxane.

One aspect is a method of treating a patient with Her2+ cancer undergoing treatment with a RXR agonist of Formula I,

-   wherein R is H, or lower alkyl of 1 to 6 carbons, or a     pharmaceutically-acceptable salt thereof, -   wherein there is evidence of therapeutic effect that is less than a     complete response, comprising continuing treatment with the RXR     agonist and initiating treatment with a taxane.

One aspect is a method of treating a patient with Her2⁺ cancer undergoing treatment with a taxane, wherein there is evidence of therapeutic effect that is less than a complete response, comprising continuing treatment with the taxane and initiating treatment with a RXR agonist of Formula I,

wherein R is H, or lower alkyl of 1 to 6 carbons; or a pharmaceutically-acceptable salt thereof.

One aspect is a method of treating a patient with Her2⁺ cancer comprising administering a RXR agonist of Formula I,

-   wherein R is H, or lower alkyl of 1 to 6 carbons; or a     pharmaceutically-acceptable salt thereof, to the patient, -   wherein the patient has received, is receiving, or is scheduled to     receive means for binding tubulin and inhibiting microtubule     disassembly, means for blocking metaphase spindle formation, or     means for inducing apoptosis by blocking Bcl-2-mediated inhibition     of apoptosis.

One aspect is a method of treating a patient with Her2+ cancer comprising administering an RXR agonist, wherein the patient has received, is receiving, is scheduled to receive a taxane.

With respect to any of the above aspects, some embodiments further comprise administering thyroid hormone.

With respect to any of the above aspects, in some embodiments the compound of Formula I or the means for activating RXR/Nurr1 heterodimeric receptors or rexinoid means for inhibiting tumor growth is the compound of Formula II:

With respect to any of the above aspects, in some embodiments the taxane is paclitaxel. With respect to any of the above aspects, in some embodiments the taxane is docetaxel.

With respect to any of the above aspect, in some embodiments the Her2+ cancer is gastroesophageal cancer, ovarian cancer, stomach cancer, adenocarcinoma of the lung, uterine cancer (such as serous endometrial carcinoma), or salivary duct carcinoma.

With respect to any of the above aspects, in some embodiments, the combination of the taxane and RXR agonist has a growth inhibitory effect that is greater than the additive growth inhibitory effects of each of the two agents alone.

With respect to any of the above aspects, some embodiments further entail administration of additional anticancer agents.

One aspect is a combination of a taxane and a compound of Formula I.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 depicts a three-dimensional plot depicting the growth inhibitory effects of IRX4204 and paclitaxel, alone and in combination, on breast cancer cell line AU565.

FIG. 2 depicts a plot of Combination Index (CI) vs. Fraction Affected (Fa) for the growth inhibition of IRX4204 and paclitaxel, in combination, on breast cancer cell line AU565. This is the same data presented in Table 1. Each cluster of data points is a single concentration of paclitaxel with each point in the cluster being a different concentration of IRX4204: 2.5 nM, 5.0 and 10.0 nM paclitaxel red (dark grey), orange (medium grey), and yellow (light grey), respectively.

FIG. 3 depicts a three-dimensional plot depicting the growth inhibitory effects of IRX4204 and paclitaxel, alone and in combination, on breast cancer cell line SkBr3.

FIG. 4 depicts a plot of CI vs. Fa for the growth inhibition of IRX4204 and paclitaxel, in combination, on breast cancer cell line SkBr3. Each cluster of data points is a single concentration of paclitaxel with each point in the cluster being a different concentration of IRX4204: 2.5 nM, 5.0 and 10.0 nM paclitaxel red (dark grey), orange (medium grey), and yellow (light grey), respectively.

DESCRIPTION

There is a large and ever growing number of agents that have shown their potential for cancer treatment in the laboratory and/or clinic. Despite this, cancer remains a difficult disease to cure or control. Combining agents has potential for improving outcomes, but it is difficult to predict which of the myriad possibilities will actually lead to improved effect, and in what kinds of cancers. Described herein is a combination of a taxane and a RXR agonist that act together synergistically to inhibit the growth of Her2⁺ cancer cells.

The methods of treating Her⁺ cancer with a taxane and a RXR agonist comprise various aspects. The cancer may initially be treated with one of the agents, and later the treatment regimen is modified to include treatment with the other agent. In some aspects, a taxane is initially administered and later administration of a RXR agonist is added to the treatment regimen. In other aspects, a RXR agonist is initially administered and later administration of a taxane is added to the treatment regimen. In some embodiments of these aspects, the modification to add the second agent may be made because treatment with the sole agent was in some way unsatisfactory. That is the cancer may have continued to progress or something less than a complete response, such as disease stabilization or a partial response, was obtained.

In some aspects, treatment may be initiated with one agent with the intent to initiate administration with the other agent at a later time. In some aspects, treatment with both agents is initiated in the same timeframe. In some such embodiments, the first dose of the second agent is administered not later than the second dose of the first agent. In all aspects, for some interval of time the patient is receiving both agents on an overlapping schedule of administration, so that the effects of both agents overlap in time.

The synergy that can be achieved with appropriate dosage selection can be important to obtain an improved response to treatment. In other embodiments, a similar response is obtained, but lesser side-effects or toxicities are experience due to the use of lower dosages of one, the other, or both agents.

In some embodiments, thyroid hormone is also administered. It has been observed that use of thyroid hormone in conjunction with IRX4202 increases the physiologic or therapeutic effect as compared to that produced by either agent used alone. This effect is not the same as reversing any hypothyroidism that might be induced by higher doses of IRX4204. Typically, a dosage of 10 mg/day of IRX4204 free acid in an adult human does not result in hypothyroidism and produces a therapeutic effect. A dosage of 20 mg/day of IRX4204 free acid in an adult human may induce a mild hypothyroidism is some individuals.

RXR Agonists

Preclinical studies suggest that selective activation of Retinoid X Receptors (RXR), which modulate functions associated with differentiation, inhibition of cell growth, apoptosis and metastasis, with RXR-acting agents (rexinoids) may be useful in treating a variety of diseases associated with the biochemical functions modulated by RXR.

The Retinoic Acid Receptors (RARs) and RXRs and their cognate ligands function by distinct mechanisms. The term “RAR” as used herein refers to one or more of RARα, RARβ, or RARy. The term “RXR” as used herein refers to one or more of RXRα, RXRβ, or RXRy. A RAR biomarker is a distinctive biological, biochemical or biologically derived indicator that signifies patient RAR activity. RAR biomarkers include, but are not limited to, CYP26 levels, CRBPI levels, and the like, and combinations thereof.

In some embodiments, the RAR activation threshold means one or more of a CYP26 level which is 25% increased over baseline and a CRBPI level 25% increased over baseline. The RARs form heterodimers with RXRs and these RAR/RXR heterodimers bind to specific response elements in the promoter regions of target genes. The binding of RAR agonists to the RAR receptor of the heterodimer results in activation of transcription of target genes leading to retinoid effects. The disclosed RXR agonists do not activate RAR/RXR heterodimers. RXR heterodimer complexes like RAR/RXR can be referred to as non-permissive RXR heterodimers as activation of transcription due to ligand-binding occurs only at the non-RXR protein (e.g., RAR); activation of transcription does not occur due to ligand binding at the RXR.

RXRs also interact with nuclear receptors other than RARs and RXR agonists and may elicit some of their biological effects by binding to such RXR/receptor complexes. These RXR/receptor complexes can be referred to as permissive RXR heterodimers as activation of transcription due to ligand-binding could occur at the RXR, the other receptor, or both receptors. Examples of permissive RXR heterodimers include, without limitation, peroxisome proliferator activated receptor/RXR (PPAR/RXR), farnesyl X receptor/RXR (FXR/RXR), nuclear receptor related-1 protein (Nurr1/RXR) and liver X receptor/RXR (LXR/RXR). Alternately, RXRs may form RXR/RXR homodimers which can be activated by RXR agonists leading to rexinoid effects. Also, RXRs interact with proteins other than nuclear receptors and ligand binding to an RXR within such protein complexes can also lead to rexinoid effects. Due to these differences in mechanisms of action, RXR agonists and RAR agonists elicit distinct biological outcomes and even in the instances where they mediate similar biological effects, they do so by different mechanisms. Moreover, the unwanted side effects of retinoids, such as pro-inflammatory responses or mucocutaneous toxicity, are mediated by activation of one or more of the RAR receptor subtypes. Stated another way, biological effects mediated via RXR pathways would not induce pro-inflammatory responses, and thus, would not result in unwanted side effects.

Thus, aspects of the present specification provide, in part, a RXR agonist. As used herein, the term “RXR agonist”, is synonymous with “selective RXR agonist” and refers to a compound that selectively binds to one or more RXR receptors like a RXRα, a RXRβ, or a RXRy in a manner that elicits gene transcription via an RXR response element. As used herein, the term “selectively binds,” when made in reference to a RXR agonist, refers to the discriminatory binding of a RXR agonist to the indicated target receptor like a RXRα, a RXRβ, or a RXRy such that the RXR agonist does not substantially bind with non-target receptors like a RARα, a RARβ or a RARy. In some embodiments, the term “RXR agonist” includes esters of RXR agonist.

For each of the herein disclosed embodiments, the RXR agonists can be compounds having the structure of Formula I

wherein R is H, or lower alkyl of 1 to 6 carbons, or a pharmaceutically acceptable salt thereof.

Also disclosed herein are esters of RXR agonists. An ester may be derived from a carboxylic acid of C1, or an ester may be derived from a carboxylic acid functional group on another part of the molecule, such as on a phenyl ring. While not intending to be limiting, an ester may be an alkyl ester, an aryl ester, or a heteroaryl ester. The term alkyl has the meaning generally understood by those skilled in the art and refers to linear, branched, or cyclic alkyl moieties. C₁₋₆ alkyl esters are particularly useful, where alkyl part of the ester has from 1 to 6 carbon atoms and includes, but is not limited to, methyl, ethyl, propyl, isopropyl, n-butyl, sec-butyl, iso-butyl, t-butyl, pentyl isomers, hexyl isomers, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, and combinations thereof having from 1-6 carbon atoms, etc. In some embodiments the RXR agonist is the ethyl ester of formula I.

In some embodiments the RXR agonist is 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydron-aphth-7-yl]2(E), 4(E) heptadienoic acid, also known as IRX4204, and has the following chemical structure:

Pharmaceutically acceptable salts of RXR agonists can also be used in the disclosed embodiments. Compounds disclosed herein which possess a sufficiently acidic, a sufficiently basic, or both functional groups, and accordingly can react with any of a number of organic or inorganic bases, and inorganic and organic acids, to form a salt.

Acids commonly employed to form acid addition salts from RXR agonists with basic groups are inorganic acids such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, phosphoric acid, and the like, and organic acids such as p-toluenesulfonic acid, methanesulfonic acid, oxalic acid, p-bromophenyl-sulfonic acid, carbonic acid, succinic acid, citric acid, benzoic acid, acetic acid, and the like. Examples of such salts include the sulfate, pyrosulfate, bisulfate, sulfite, bisulfite, phosphate, monohydrogenphosphate, dihydrogenphosphate, metaphosphate, pyrophosphate, chloride, bromide, iodide, acetate, propionate, decanoate, caprylate, acrylate, formate, isobutyrate, caproate, heptanoate, propiolate, oxalate, malonate, succinate, suberate, sebacate, fumarate, maleate, butyne-1,4-dioate, hexyne-1,6-dioate, benzoate, chlorobenzoate, methylbenzoate, dinitrobenzoate, hydroxybenzoate, methoxybenzoate, phthalate, sulfonate, xylenesulfonate, phenylacetate, phenylpropionate, phenylbutyrate, citrate, lactate, gamma-hydroxybutyrate, glycolate, tartrate, methanesulfonate, propanesulfonate, naphthalene-1-sulfonate, naphthalene-2-sulfonate, mandelate, and the like.

Bases commonly employed to form base addition salts from RXR agonists with acidic groups include, but are not limited to, hydroxides of alkali metals such as sodium, potassium, and lithium; hydroxides of alkaline earth metal such as calcium and magnesium; hydroxides of other metals, such as aluminum and zinc; ammonia, and organic amines, such as unsubstituted or hydroxy-substituted mono-, di-, or trialkylamines; dicyclohexylamine; tributyl amine; pyridine; N-methyl,N-ethylamine; diethylamine; triethylamine; mono-, bis-, or tris-(2-hydroxy-lower alkyl amines), such as mono-, bis-, or tris-(2-hydroxyethyl)amine, 2-hydroxy-tert-butylamine, or tris-(hydroxymethyl)methylamine, N,N-di-lower alkyl-N-(hydroxy lower alkyl)-amines, such as N,N-dimethyl-N-(2-hydroxyethyl)amine, or tri-(2-hydroxyethyl)amine; N-methyl-D-glucamine; and amino acids such as arginine, lysine, and the like.

IRX4204, like some other RXR ligands, does not activate non-permissive heterodimers such as RAR/RXR. However, IRX4204, is unique in that it specifically activates the Nurr1/RXR heterodimer and does not activate other permissive RXR heterodimers such as PPAR/RXR, FXR/RXR, and LXR/RXR. Other RXR ligands generally activate these permissive RXR heterodimers. Thus, all RXR ligands cannot be classified as belonging to one class. IRX4204 belongs to a unique class of RXR ligands which specifically activate RXR homodimers and only one of the permissive RXR heterodimers, namely the Nurr1/RXR heterodimer. IRX4204 and its salts and esters may be referred to as means for activating RXR/Nurr1 heterodimeric receptors or rexinoid means for inhibiting tumor growth. It is to be understood that in the aqueous environment of the body, IRX4204 free acid and its salts and esters all produce the same anionic species - albeit with potentially different kinetics - and are expected to have similar physiologic and therapeutic effect. Accordingly, general reference herein to IRX4204 should be understood to include the salts and esters unless context dictates otherwise.

In one embodiment, the selective RXR agonist does not activate to any appreciable degree the permissive heterodimers PPAR/RXR, FXR/RXR, and LXR/RXR. In another embodiment, the selective RXR agonist, activates the permissive heterodimer Nurr1/RXR. One example of such a selective RXR agonist is 3,7-dimethyl-6(S),7(S)-methano,7-[1,1,4,4-tetramethyl-1,2,3,4-tetrahydronaphth-7-yl]2(E),4(E) heptadienoic acid (IRX4204) disclosed herein, the structure of which is shown in Formula II. In other aspects of this embodiment, the RXR agonists activates the permissive heterodimers PPAR/RXR, FXR/RXR, or LXR/RXR by 1% or less, 2% or less, 3% or less, 4% or less, 5% or less, 6% or less, 7% or less, 8% or less, 9% or less, or 10% or less relative to the ability of activating agonists to the non-RXR receptor to activate the same permissive heterodimer. Examples of RXR agonists, which activates one or more of PPAR/RXR, FXR/RXR, or LXR/RXR include LGD1069 (bexarotene) and LGD268.

Binding specificity is the ability of a RXR agonist to discriminate between a RXR receptor and a receptor that does not contain its binding site, such as a RAR receptor.

Particular embodiments provide methods of treating cancer comprising administering to a patient in need of such treatment a RXR agonist at a level below an RAR activating threshold and at or above an RXR activating threshold.

For IRX4204, the RAR EC₁₀ (the concentration effective to cause a 10% of maximal activation of the RAR) is 300 nM for the α isoform and 200 nM for the β and γ isoforms. Thus, in some embodiments, concentrations not exceeding 200 nM are considered to be below an RAR activating concentration. For IRX4204, the RXR EC₉₀ (the concentration effective to cause a 90% of maximal activation of the RXR) is 0.1 nM for the α and γ isoforms and 1 nM for the β isoform. Thus, in some embodiments concentrations of at least 0.1 nM are considered to be above an RXR activating threshold. Based on studies in humans, oral dosages of IRX4204 of 20 mg/m²/day will produce systemic concentrations that remain below 200 nM. Similarly, it is estimated that an oral dosage in the range of 0.01 to 0.02 mg/m²/day will produce systemic concentrations of 0.1 nM or greater. Thus, in various individual embodiments a dosage of IRX4204 is at least 0.01, 0.02, 0.03, 0.05, 0.1, 0.3, 0.5, 1, 3 or 5 mg/m²/day and does not exceed 150, 200, or 300 mg/m²/day, or any range bound by a pair of these values.

In other embodiments, the dosage for a human adult of the RXR agonist, for example IRX4204, is from 0.2 to 300 mg/day, such as in individual embodiments, from 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 mg/day, but not to exceed 10, 15, 20, 50, or 100 mg/day, or any range bound by a pair of these values.

The RXR agonist can be administered to a mammal using standard administration techniques, including parenteral, oral, intravenous, intraperitoneal, subcutaneous, pulmonary, transdermal, intramuscular, intranasal, buccal, sublingual, or suppository administration. The term “parenteral,” as used herein, includes intravenous, intramuscular, subcutaneous, rectal, vaginal, and intraperitoneal administration. The RXR agonist preferably is suitable for oral administration, for example as a pill, tablet or capsule. Administration may be continuous or intermittent. In certain embodiments, the total daily dosage of RXR agonist can be administered as a single dose or as two doses administered with a 24 hour period spaced 8 to 16, or 10 to 14, hours apart.

Thyroid Hormone

Both biologically sourced and synthetic thyroid hormones have been used in medicine. The major forms of thyroid hormone are referred to as T₃ (triiodothyronine) and T₄ (thyroxine). Thyroxine is less active but has a longer half-life and is sometimes considered a prohormone of triiodothyronine. As used herein, the term “thyroid hormone” refers to both thyroxine and triiodothyronine. Thyroxine (thyroid hormone T₄, levothyroxine sodium) is a tyrosine-based hormone produced by the thyroid gland and is primarily responsible for regulation of metabolism. Both have wide commercial availability and are suitable for use in the herein disclosed embodiments. However, the synthetic form of T₄, levothyroxine, is much more commonly utilized clinically (except in patients unable to convert T₄ into T₃) as its longer half-life in the body facilitates once-daily administration. In some embodiments, the administered thyroid hormone is specifically thyroxine. In some embodiments, the administered thyroid hormone is triiodothyronine.

Administration of RXR agonists, or esters thereof, may lead to the suppression of serum thyroid hormones and possibly to clinical hypothyroidism and related conditions. However, in some embodiments thyroid hormone is not co-administered (or is not primarily co-administered) to remediate a suppression of serum thyroid hormone levels. Co-administration of thyroid hormone with an RXR agonist improves the RXR agonist’s anti-cancer efficacy, as compared to the effect of the RXR agonist alone, likely through multiple mechanisms of action. The co-administered thyroid hormone can also mitigate the hypothyroid-inducing effects of the RXR agonist, thereby improving the clinical safety and tolerability of the treatment. Thus, in preferred embodiments, thyroid hormone is co-administered with an RXR agonist to improve the efficacy of the treatment, whether or not administration of the RXR agonist has caused, or is expected to cause, clinical hypothyroidism. By administration of thyroid hormone in coordination or in conjunction with the RXR agonist it is meant that the manner of administration of each of these two agents is such that the physiologic effects of the two agents overlap in time. This does not require that the RXR agonist and thyroid hormone be contained in the same composition or formulation, or that they be administered as separate compositions at the same time, by the same route of administration, or on the same schedule, though in some embodiments any of the foregoing may be the case.

Suitable thyroxine doses are generally from about 5 µg/day to about 250 µg/day orally initially with an increase in dose every 2-4 weeks as needed. In other embodiments, the suitable thyroxine dose is from about 5 µg/day to about 225 µg/day, from about 7.5 µg/day to about 200 µg/day, from about 10 µg/day to about 175 µg/day, from about 12.5 µg/day to about 150 µg/day, from about 15 µg/day to about 125 µg/day, from about 17.5 µg/day to about 100 µg/day, from about 20 µg/day to about 100 µg/day, from about 22.5 µg/day to about 100 µg/day, from about 25 µg/day to about 100 µg/day, from about 5 µg/day to about 200 µg/day, from about 5 µg/day to about 100 µg/day, from about 7.5 µg/day to about 90 µg/day, from about 10 µg/day to about 80 µg/day, from about 12.5 µg/day to about 60 µg/day, or from about 15 µg/day to about 50 µg/day. Increases in dose are generally made in increments of about 5 µg/day, about 7.5 µg/day, about 10 µg/day, about 12.5 µg/day, about 15 µg/day, about 20 µg/day, or about 25 µg/day. In certain embodiments, the suitable thyroid hormone dose is a dose able to produce serum levels of T₄ in the top 50%, the top 60%, the top 70%, the top 80%, or the top 90% of the normal range for the testing laboratory. As the normal range of T₄ levels may vary by testing laboratory, the target T₄ levels are based on normal ranges determined for each particular testing laboratory.

For each embodiment involving a combination of RXR agonist and taxane, there is a parallel embodiment in which the combination further comprises thyroid hormone.

Taxanes

Taxanes are classified as anti-neoplastic agents, specifically anti-mitotic and anti-microtubule agents. Taxanes interfere with the growth of cancer cells by blocking mitosis. They can also induce apoptosis, killing the cell. Taxanes that have received marketing approval for the treatment of cancer include paclitaxel and docetaxel. As used herein, the term taxane refers to compounds that have both the structural features associate with taxanes and anti-neoplastic activity.

Paclitaxel (CAS number 33069-62-4) has the structure:

Docetaxel (CAS number 114977-28-5) has the structure:

Paclitaxel and doceltaxel constitute means for binding tubulin and inhibiting microtubule disassembly, means for blocking metaphase spindle formation, or means for inducing apoptosis by blocking Bcl-2-mediated inhibition of apoptosis.

Taxanes are typically administered by intravenous infusion at two to three week intervals depending on the cancer being treated. Docetaxel is typically administered at a dosage of 75 mg/m² of body surface area. Paclitaxel is typically administered at a dosage of 135 or 175 mg/m² of body surface area. Other details of using these drugs in the treatment of cancer including pretreatment, use with other drugs, modified dosages, and the like are known to the person of skill in the art and can be found, for example, in their Prescribing Information for paclitaxel at https://wwwDOTaccessdataDOTfdaDOTgov/drugsatfda_docs/label/2011/020262s0491bl.pdf, and docetaxel at https://wwwDOTaccessdataDOTfdaDOTgov/drugsatfda_docs/label/2020/020449s0841bl.pdf, which are incorporated herein in their entirety.

Combinations

Further embodiments include a combination comprising a RXR agonist as herein described and a taxane. Some embodiments further comprise a thyroid hormone. Due to the differing chemical properties of these agents, and the potentially differing routes and/or schedules of administration, they will not necessarily be co-formulated, though in some embodiments, they may be. They may be combined in the sense that they are provided together by a pharmacy or medical professional (a doctor, a nurse practitioner, etc.). They may also constitute a combination in that they are administered to be present in the patient’s body at the same time.

Further embodiments include kits comprising the above combinations of agents. The kits may additionally comprise solvents, diluents, injectors, and the like that may facilitate administration of one or more of the therapeutic agents. The kits may further comprise instructions for the coordinated use of the therapeutic agents utilized in the disclosed methods, whether or not any particular agent is supplied in the kit.

Pharmaceutical Compositions and Formulations

The various component active agents used in the herein described treatments will typically exist as pharmaceutical compositions or formulations. Such compositions or formulations may be a liquid formulation, semi-solid formulation, or a solid formulation. A formulation disclosed herein can be produced in a manner to form one phase, such as, e.g., an oil or a solid. Alternatively, a formulation disclosed herein can be produced in a manner to form two phases, such as, e.g., an emulsion. A pharmaceutical composition disclosed herein intended for such administration may be prepared according to any method known to the art for the manufacture of pharmaceutical compositions.

Liquid formulations suitable for parenteral injection or for nasal sprays may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions and sterile powders for reconstitution into sterile injectable solutions or dispersions. Formulations suitable for nasal administration may comprise physiologically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions. Examples of suitable aqueous and nonaqueous carriers, diluents, solvents or vehicles include water, ethanol, polyols (propylene glycol, polyethyleneglycol (PEG), glycerol, and the like), suitable mixtures thereof, vegetable oils (such as olive oil) and injectable organic esters such as ethyl oleate. Proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersions and by the use of surfactants.

A pharmaceutical composition disclosed herein can optionally include a pharmaceutically acceptable carrier that facilitates processing of an active compound into pharmaceutically acceptable compositions. As used herein, the term “pharmaceutically acceptable” refers to those compounds, materials, compositions, and/or dosage forms which are, within the scope of sound medical judgment, suitable for contact with the tissues of human beings and animals without excessive toxicity, irritation, allergic response, or other problem complications commensurate with a reasonable benefit/risk ratio. (This definition is also application to the phrase “pharmaceutically-acceptable salts”). As used herein, the term “pharmacologically acceptable carrier” is synonymous with “pharmacological carrier” and refers to any carrier that has substantially no long term or permanent detrimental effect when administered and encompasses terms such as “pharmacologically acceptable vehicle, stabilizer, diluent, additive, auxiliary, or excipient.” Such a carrier generally is mixed with an active compound or permitted to dilute or enclose the active compound and can be a solid, semi-solid, or liquid agent. It is understood that the active compounds can be soluble or can be delivered as a suspension in the desired carrier or diluent. Any of a variety of pharmaceutically acceptable carriers can be used including, without limitation, aqueous media such as, e.g., water, saline, glycine, hyaluronic acid and the like; solid carriers such as, e.g., starch, magnesium stearate, mannitol, sodium saccharin, talcum, cellulose, glucose, sucrose, lactose, trehalose, magnesium carbonate, and the like; solvents; dispersion media; coatings; antibacterial and antifungal agents; isotonic and absorption delaying agents; or any other inactive ingredient. Selection of a pharmacologically acceptable carrier can depend on the mode of administration. Except insofar as any pharmacologically acceptable carrier is incompatible with the active compound, its use in pharmaceutically acceptable compositions is contemplated. Non-limiting examples of specific uses of such pharmaceutical carriers can be found in Pharmaceutical Dosage Forms and Drug Delivery Systems (Howard C. Ansel et al., eds., Lippincott Williams & Wilkins Publishers, 7^(th) ed. 1999); Remington: The Science and Practice of Pharmacy (Alfonso R. Gennaro ed., Lippincott, Williams & Wilkins, 20^(th) ed. 2000); Goodman & Gilman’s The Pharmacological Basis of Therapeutics (Joel G. Hardman et al., eds., McGraw-Hill Professional, 10^(th) ed. 2001); and Handbook of Pharmaceutical Excipients (Raymond C. Rowe et al., APhA Publications, 4^(th) edition 2003). These protocols are routine and any modifications are well within the scope of one skilled in the art and from the teaching herein.

A pharmaceutical composition disclosed herein can optionally include, without limitation, other pharmaceutically acceptable components (or pharmaceutical components), including, without limitation, buffers, preservatives, tonicity adjusters, salts, antioxidants, osmolality adjusting agents, physiological substances, pharmacological substances, bulking agents, emulsifying agents, wetting agents, sweetening or flavoring agents, and the like. Various buffers and means for adjusting pH can be used to prepare a pharmaceutical composition disclosed herein, provided that the resulting preparation is pharmaceutically acceptable. Such buffers include, without limitation, acetate buffers, borate buffers, citrate buffers, phosphate buffers, neutral buffered saline, and phosphate buffered saline. It is understood that acids or bases can be used to adjust the pH of a composition as needed. Pharmaceutically acceptable antioxidants include, without limitation, sodium metabisulfite, sodium thiosulfate, acetylcysteine, butylated hydroxyanisole, and butylated hydroxytoluene. Useful preservatives include, without limitation, benzalkonium chloride, chlorobutanol, thimerosal, phenylmercuric acetate, phenylmercuric nitrate, a stabilized oxy chloro composition, such as, e.g., sodium chlorite and chelants, such as, e.g., DTPA or DTPA-bisamide, calcium DTPA, and CaNaDTPA-bisamide. Tonicity adjustors useful in a pharmaceutical composition include, without limitation, salts such as, e.g., sodium chloride, potassium chloride, mannitol or glycerin and other pharmaceutically acceptable tonicity adjustor. The pharmaceutical composition may be provided as a salt and can be formed with many acids, including but not limited to, hydrochloric, sulfuric, acetic, lactic, tartaric, malic, succinic, etc. Salts tend to be more soluble in aqueous or other protonic solvents than are the corresponding free base forms. It is understood that these and other substances known in the art of pharmacology can be included in a pharmaceutical composition useful in the invention.

Pharmaceutical formulations suitable for administration by inhalation include fine particle dusts or mists, which may be generated by means of various types of metered, dose pressurized aerosols, nebulizers, or insufflators.

Semi-solid formulations suitable for topical administration include, without limitation, ointments, creams, salves, and gels. In such solid formulations, the active compound may be admixed with at least one inert customary excipient (or carrier) such as, a lipid and/or polyethylene glycol.

Solid formulations suitable for oral administration include capsules, tablets, pills, powders and granules. In such solid formulations, the active compound may be admixed with at least one inert customary excipient (or carrier) such as sodium citrate or dicalcium phosphate or (a) fillers or extenders, as for example, starches, lactose, sucrose, glucose, mannitol and silicic acid, (b) binders, as for example, carboxymethylcellulose, alignates, gelatin, polyvinylpyrrolidone, sucrose and acacia, (c) humectants, as for example, glycerol, (d) disintegrating agents, as for example, agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain complex silicates and sodium carbonate, (e) solution retarders, as for example, paraffin, (f) absorption accelerators, as for example, quaternary ammonium compounds, (g) wetting agents, as for example, cetyl alcohol and glycerol monostearate, (h) adsorbents, as for example, kaolin and bentonite, and (i) lubricants, as for example, talc, calcium stearate, magnesium stearate, solid polyethylene glycols, sodium lauryl sulfate or mixtures thereof. In the case of capsules, tablets and pills, the dosage forms may also comprise buffering agents.

The small molecule components of the various embodiments, that is, the RXR agonist and the thyroid hormone are capable of being formulated in solid, oral dosage forms. The taxane components are generally formulated as liquids, typically for intravenous infusion. In alternative embodiments the taxane components may be supplied in lyophilized form for reconstitution as a liquid locally at the site of treatment, where they are also typically infused intravenously into the patient.

The antibody components are generally formulated as liquids, typically for intravenous infusion. In alternative embodiments the antibody components may be supplied in lyophilized form for reconstitution as a liquid locally at the site of treatment, where they are also typically infused intravenously into the patient. While intravenous infusion is typical, in alternative embodiments the antibody may be administered by another route of administration, such as subcutaneous injection or infusion.

Treatment

As used herein, the terms “treatment,” “treating,” and the like refer to obtaining a desired pharmacologic and/or physiologic effect. This may be observed directly as a slowing of tumor growth, stabilization of disease, or a partial or complete response (that is, tumor regression or elimination of tumors), or extended overall or disease-free survival. Treatment may also be observed as an amelioration or reduction of symptoms related to the underlying cancer. However, as cancer treatment, the disclosed embodiments’ aim and mechanism is directed to inhibiting, stabilizing, or reducing tumor growth (including metastases), or partially or completely eliminating tumors, or extending overall or disease-free survival; effects on other cancer symptoms are secondary. Direct treatment of such other symptoms (for example, pain, nausea, loss of appetite, etc.) is not within the scope of treating cancer as used herein. That is, treating a symptom, for example, cachexia in a cancer patient is not treating cancer. However, an agent that treats cancer (e.g., has an impact on the growth and/or spread of cancer) may also ameliorate a symptom, such as cachexia, either indirectly, through its effect on the cancer, or directly, through a pleiotropic effect. A “therapeutically effective amount” refers to an amount effective, at dosages and for periods of time necessary, to achieve a desired therapeutic result. The therapeutically effective amount may vary according to factors such as the disease state, age, sex, and weight of the individual, and the ability of the Her2-targeted therapy, RXR agonist, and if used, thyroid hormone, to elicit a desired response in the individual.

However, the dose administered to a mammal, particularly a human, in the context of the present methods, should be sufficient to effect a therapeutic response in the mammal over a reasonable timeframe. One skilled in the art will recognize that the selection of the exact dose and composition and the most appropriate delivery regimen will also be influenced by inter alia the pharmacological properties of the formulation, the nature and severity of the condition being treated, and the physical condition and mental acuity of the recipient, as well as the potency of the specific compound, the age, condition, body weight, sex and response of the patient to be treated, and the stage/severity of the disease.

Treatment activity includes the administration of the medicaments, dosage forms, and pharmaceutical compositions described herein to a patient, especially according to the various methods of treatment disclosed herein, whether by a healthcare professional, the patient his/herself, or any other person. Treatment activities include the orders, instructions, and advice of healthcare professionals such as physicians, physician’s assistants, nurse practitioners, and the like that are then acted upon by any other person including other healthcare professionals or the patient his/herself. In some embodiments, treatment activity can also include encouraging, inducing, or mandating that a particular medicament, or combination thereof, be chosen for treatment of a condition - and the medicament is actually used - by approving insurance coverage for the medicament, denying coverage for an alternative medicament, including the medicament on, or excluding an alternative medicament, from a drug formulary, or offering a financial incentive to use the medicament, as might be done by an insurance company or a pharmacy benefits management company, and the like. In some embodiments, treatment activity can also include encouraging, inducing, or mandating that a particular medicament be chosen for treatment of a condition - and the medicament is actually used - by a policy or practice standard as might be established by a hospital, clinic, health maintenance organization, medical practice or physicians group, and the like.

To benefit from the combined effect of a RXR agonist of Formula I (or pharmaceutically acceptable salt or ester thereof) and a taxane, embodiments include methods of treatment comprising or consisting of administering RXR agonist of Formula I (or pharmaceutically acceptable salt thereof) and a taxane to a patient having a Her2⁺ cancer. Some embodiments further comprise administration of thyroid hormone in coordination with administration of the RXR agonist. In some embodiments the Her2⁺ cancer is a Her2⁺ breast cancer. In some embodiments the Her2⁺ cancer is a Her2⁺ gastroesophageal cancer, ovarian cancer, stomach cancer, adenocarcinoma of the lung, uterine cancer (such as serous endometrial carcinoma), or salivary duct carcinoma. Some embodiments specifically include one or more of these cancers. Other embodiments specifically exclude one or more of these cancers.

In various embodiments, the herein disclosed treatments may be applied as a primary therapy, as a debulking therapy prior to surgical removal of tumor, or as an adjuvant therapy subsequent to any mode of primary therapy (especially surgery) to address residual disease and/or lower the risk of recurrent cancer.

In some embodiments, the patient having a Her2⁺ cancer has not been previously treated with either RXR agonist of Formula I (or pharmaceutically acceptable salt thereof) or a taxane. In some embodiments the patient has been previously treated with RXR agonist of Formula I (or pharmaceutically acceptable salt thereof) and has achieved stable disease or a partial response (in some embodiments, as defined by RECIST or iRECIST criteria) - that is, the cancer is sensitive to RXR agonist of Formula I (or pharmaceutically acceptable salt thereof) -and a taxane is added to the treatment regimen. In some embodiments the patient has been previously treated with a taxane and has achieved stable disease or a partial response (in some embodiments, as defined by RECIST or iRECIST criteria) - that is, the cancer is sensitive to the taxane - and RXR agonist of Formula I (or pharmaceutically acceptable salt thereof) is added to the treatment regimen.

Thus some embodiments comprise administration of an RXR agonist to a patient with a Her2⁺ tumor who has received, is receiving, or is scheduled to receive, a taxane. Some embodiments comprise administration of an RXR agonist to a patient in whom a taxane has had some therapeutic effect (less than a complete response), that is administration of the RXR agonist is added to the therapeutic regimen for the taxane. Some embodiments comprise administration of a taxane to a patient in whom an RXR agonist (or RXR agonist in conjunction with thyroid hormone) has had some therapeutic effect (less than a complete response), that is administration of the taxane is added to the therapeutic regimen for the RXR agonist.

Therapeutic efficacy can be monitored by periodic assessment of treated patients. For repeated administrations over several days or longer, the treatment can be repeated until a desired suppression of disease or disease symptoms occurs. However, other dosage regimens may be useful and are within the scope of the present disclosure.

The effectiveness of cancer therapy is typically measured in terms of “response.” The techniques to monitor responses can be similar to the tests used to diagnose cancer such as, but not limited to:

-   A lump or tumor involving some lymph nodes can be felt and measured     externally by physical examination. -   Some internal cancer tumors will show up on an x-ray or CT scan and     can be measured with a ruler. -   Blood tests, including those that measure organ function can be     performed. -   A tumor marker test can be done for certain cancers.

Regardless of the test used, whether blood test, cell count, or tumor marker test, it is repeated at specific intervals so that the results can be compared to earlier tests of the same type.

Response to cancer treatment is defined several ways:

-   Complete response - all of the cancer or tumor disappears; there is     no evidence of disease. Expression level of tumor marker (if     applicable) may fall within the normal range. -   Partial response - the cancer has shrunk by a percentage but disease     remains. Levels of a tumor marker (if applicable) may have fallen     (or increased, based on the tumor marker, as an indication of     decreased tumor burden) but evidence of disease remains. -   Stable disease - the cancer has neither grown nor shrunk; the amount     of disease has not changed. A tumor marker (if applicable) has not     changed significantly. -   Disease progression - the cancer has grown; there is more disease     now than before treatment. A tumor marker test (if applicable) shows     that a tumor marker has risen.

Other measures of the efficacy of cancer treatment include intervals of overall survival (that is time to death from any cause, measured from diagnosis or from initiation of the treatment being evaluated)), cancer-free survival (that is, the length of time after a complete response cancer remains undetectable), and progression-free survival (that is, the length of time after disease stabilization or partial response that resumed tumor growth is not detectable).

There are two standard methods for the evaluation of solid cancer treatment response with regard to tumor size (tumor burden), the WHO and RECIST standards. These methods measure a solid tumor to compare a current tumor with past measurements or to compare changes with future measurements and to make changes in a treatment regimen. In the WHO method, the solid tumor’s long and short axes are measured with the product of these two measurements is then calculated; if there are multiple solid tumors, the sum of all the products is calculated. In the RECIST method, only the long axis is measured. If there are multiple solid tumors, the sum of all the long axes measurements is calculated. However, with lymph nodes, the short axis is measured instead of the long axis. There is also a variation of the RECIST method for immunotherapies (iRECIST) which takes into account distinctive behaviors linked to these types of therapeutics, such as delayed responses after pseudoprogression. Both the RECIST 1.1 guidelines and the iRecist guidelines are incorporated by reference herein in their entirety.

In some embodiments of the herein disclosed methods, the tumor burden of a treated patient is reduced by about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55% about 60%, about 65%, about 70%, about 75%, about 80%, about 90%, about 95%, about 100%, or any range bound by these values.

In other embodiments, the 1-year survival rate of treated subjects is increased by about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55% about 60%, about 65%, about 70%, about 75%, about 80%, about 90%, about 95%, about 100%, or any range bound by these values.

In other embodiments, the 5-year survival rate of treated subjects is increased by about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55% about 60%, about 65%, about 70%, about 75%, about 80%, about 90%, about 95%, about 100%, or any range bound by these values.

In other embodiments, the 10-yearsurvival rate of treated subjects is increased by about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55% about 60%, about 65%, about 70%, about 75%, about 80%, about 90%, about 95%, about 100%, or any range bound by these values.

In yet other embodiments, the subject has a sustained remission of at least 6 months, at least 7 months, at least 8 months, at least 9 months, at least 10 months, at least 11 months, at least 12 months, at least 14 months, at least 16 months, at least 18 months, at least 20 months, at least 22 months, at least 24 months, at least 27 months, at least 30 months, at least 33 months, at least 36 months, at least 42 months, at least 48 months, at least 54 months, or at least 60 months or more.

In other embodiments, the methods may additionally help to treat or alleviate conditions, symptoms, or disorders related to cancer. In some embodiments, these conditions or symptoms may include, but are not limited to, anemia, asthenia, cachexia, Cushing’s syndrome, fatigue, gout, gum disease, hematuria, hypercalcemia, hypothyroidism, internal bleeding, hair loss, mesothelioma, nausea, night sweats, neutropenia, paraneoplastic syndromes, pleuritis, polymyalgia rheumatica, rhabdomyolysis, stress, swollen lymph nodes, thrombocytopenia, vitamin D deficiency, or weight loss. While a cancer treatment may reduce or treat associated symptoms, treating symptoms associated with cancer, is not treating cancer if there is no expectation that tumor will be reduced or eliminated or their growth or spread will be inhibited.

Toxicities and adverse events are sometimes graded according to a 5 point scale. A grade 1 or mild toxicity is asymptomatic or induces only mild symptoms; may be characterized by clinical or diagnostic observations only; and intervention is not indicated. A grade 2 or moderate toxicity may impair activities of daily living (such as preparing meals, shopping, managing money, using the telephone, etc.) but only minimal, local, or non-invasive interventions are indicated. Grade 3 toxicities are medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization is indicated; activities of daily living related to self-care (such as bathing, dressing and undressing, feeding oneself, using the toilet, taking medications, and not being bedridden) may be impaired. Grade 4 toxicities are life-threatening and urgent intervention is indicated. Grade 5 toxicity produces an adverse event-related death. Thus in various embodiments, use of an RXR agonist, or RXR agonist and thyroid hormone, reduces the grade of a toxicity that would otherwise be associated with use of the Her2-targered therapy, by allowing a lower dose to be used without substantial sacrifice of efficacy. In some embodiments, use of an RXR agonist, or RXR agonist and thyroid hormone, in combination with the Her2-targeted therapeutic agent limits a toxicity to grade 1 or less, or produces no observation of the toxicity, without substantial reduction of efficacy as would be expected from the Her2-targeted therapeutic agent alone. In some embodiments, the combined use of the Her2-targeted therapeutic agent and the RXR agonist, or RXR agonist and thyroid hormone, allows continued use of the Her2-targeted therapeutic agent at a lower dosage with therapeutic effect in instances where treatment with the Her2-targeted therapeutic agent would have had to have been discontinued due to unacceptable toxicity. In some of these embodiments, the Her2-targeted therapeutic agent comprises a Her2 kinase inhibitor.

The combination of the disclosed RXR agonists and the Her2 targeted therapeutics are synergistic in effect. That is, they interact in a positive manner to produce a greater inhibition of tumor cell growth than would be expected from the independent (non-interacting) effects of the two. Thus, some embodiments produce improved efficacy. Other embodiments allow for the reduction of dosage in order to reduce toxicity while still achieving at least similar efficacy as provided by an individual therapeutic agent. In some embodiments, both reduced toxicity and improved efficacy (as compared to the more toxic single agent) is achieved.

For each method of treatment there are further parallel embodiments related to the foregoing methods directed to use of the RXR agonist in conjunction with a taxane, or a taxane and thyroid hormone, to treat Her2⁺ cancer; directed to use of the RXR agonist in the manufacture of a medicament for use in combination with a taxane, or a taxane and thyroid hormone, to treat Her2⁺ cancer.

LIST OF PARTICULAR EMBODIMENTS

The following listing of embodiments is illustrative of the variety of embodiments with respect to breadth, combinations and sub-combinations, class of invention, etc., elucidated herein, but is not intended to be an exhaustive enumeration of all embodiments finding support herein.

Embodiment 1. A method of administering a taxane and a RXR agonist of Formula I,

wherein R is H, or lower alkyl of 1 to 6 carbons, or a pharmaceutically-acceptable salt thereof, to the patient.

Embodiment 2. The method of Embodiment 1, wherein the patient had previously been treated with a taxane but not with the RXR agonist and had obtained less than a complete response.

Embodiment 3. The method of Embodiment 1, wherein the patient had previously been treated with the RXR agonist, but not the taxane.

Embodiment 4. A method of treating a Her2⁺ cancer in a patient in need thereof comprising administering means for binding tubulin and inhibiting microtubule disassembly, means for blocking metaphase spindle formation, or means for inducing apoptosis by blocking Bcl-2-mediated inhibition of apoptosis and a RXR agonist of Formula I,

wherein R is H, or lower alkyl of 1 to 6 carbons, or a pharmaceutically-acceptable salt thereof, to the patient.

Embodiment 5. A method of treating a Her2⁺ cancer in a patient in need thereof comprising administering a taxane and means for activating RXR/Nurr1 heterodimeric receptors or rexinoid means for inhibiting tumor growth, to the patient.

Embodiment 6. The method of any one of Embodiments 1-5, further comprising administering thyroid hormone.

Embodiment 7. The method of any one of Embodiments 1-3 or 5-6, wherein the RXR agonist of Formula 1 is the compound of Formula II:

Embodiment 8. The method of any one of Embodiments 1-4 or 6, wherein the taxane is paclitaxel.

Embodiment 9. The method of any one of Embodiments 1-4 or 6, wherein the taxane is docetaxel.

Embodiment 10. The method of any one of Embodiments 1-9, wherein the Her2⁺ cancer is gastroesophageal cancer, ovarian cancer, stomach cancer, adenocarcinoma of the lung, uterine cancer, or salivary duct carcinoma.

Embodiment 11. The method of any one of Embodiments 1-9, wherein the Her2⁺ cancer is breast cancer.

Embodiment 12 The method of any one of Embodiments 1-11, the combination of the taxane and RXR agonist has a growth inhibitory effect that is greater than the additive growth inhibitory effects of each of the two agents alone.

Embodiment 13. The method of any one of Embodiments 1-12, further comprising administration of an additional anticancer agent.

EXAMPLES

The following non-limiting examples are provided for illustrative purposes only in order to facilitate a more complete understanding of representative embodiments now contemplated. These examples should not be construed to limit any of the embodiments described in the present specification,

Example 1 Assessment of Synergy in Inhibition of Tumor Cell Growth by IRX4204 and Paclitaxel

The Her2⁺ AU565 human breast cancer cell line was seeded at 500-3000 cells per well in 96-well plates and treated with paclitaxel [2.5, 5 or 10 nM] or DMSO (0.1%) in combination with IRX4204 [10, 100 or 1000 nM]. After 6-10 days of treatment, cells were fixed with 4% paraformaldehyde. Nuclei were stained with DAPI, imaged using ImageXpress® Pico (Molecular Devices) and counted using CellReporterXpress®Analysis Software. Each data point represents the average of six replicates. Percent CV among replicates is less than 7%.

AU565 cells were sensitive to both paclitaxel and IRX4204 as sole agents. The combination of the two agents inhibited growth to a greater degree that either alone (FIG. 1 ). To assess whether the increased inhibition from the combination of agents was additive or synergistic, the Combination Index (CI) was calculated using the computational program CompuSyn (ComboSyn, Inc.). The results are presented in Table 1 and FIG. 2 .

TABLE 1 CI Data for Non-Constant Combination (IRX4204 and Paclitaxel) IRX4204 Dose (nM) Paclitaxel Dose (nM) Effect* Cl** 1000 10.0 0.97250 0.89064 100 10.0 0.97094 0.90129 10 10.0 0.96744 0.92369 1000 5.0 0.78365 0.71718 100 5.0 0.74997 0.74603 10 5.0 0.75654 0.74053 1000 2.5 0.59332 0.54410 100 2.5 0.54654 0.67120 10 2.5 0.52694 0.53454 * Fraction affected ** Combination Index

A combination index of about 1 indicates additivity of effect, >1 indicates an antagonistic effect, and <1 indicates a synergistic effect. Accordingly, there was synergy between IRX4204 and paclitaxel at all points. The clustering of the data points for each concentration of paclitaxel in FIG. 2 reflects that there is not a strong dose effect from IRX4204 in the tested concentration range, as IRX4204 is having near maximal at all of the concentrations. The data indicate that a stronger synergy signal would be observed with lower concentrations of IRX4204.

Example 2 Assessment of Synergy in Inhibition of Tumor Cell Growth by IRX4204 and Paclitaxel with Additional Cell Lines

At the concentrations used in Example 1, IRX4204 had near maximal effect as a sole agent at all concentrations making it difficult to observe synergy. Additional growth inhibition studies were conducted with SkBr3 (Her2⁺) human breast cancer. IRX4204 was used at concentrations of 0, 0.00001, 0.0001, 0.001, 0.01, 0.1, 1.0, 10, 100, and 1000 nM and paclitaxel was used at concentrations of 0, 2, 3, 6, 8, and 10 nM. Synergy was again observed for growth inhibition of the Her2⁺ cell lines. The combination of the two agents inhibited growth to a greater degree that either alone (FIG. 3 ). FIG. 4 depicts that synergy with IRX4204 was seen at all concentrations of paclitaxel.

Additional growth inhibition studies are conducted with additional cancer cell lines (ZR751 (Her2⁺), MDAMB231 (Her2⁻), MCF7 (Her2⁻) human breast cancer, and MMTV-ErbB2 clone #7A-99 (Her2⁺) murine breast cancer). IRX4204 is used at lower concentrations including 0.1 nM and 1.0 nM. Synergy is again observed for growth inhibition of the Her2⁺ cell lines.

In closing, it is to be understood that although aspects of the present specification are highlighted by referring to specific embodiments, one skilled in the art will readily appreciate that these disclosed embodiments are only illustrative of the principles of the subject matter disclosed herein. Therefore, it should be understood that the disclosed subject matter is in no way limited to a particular methodology, protocol, and/or reagent, etc., described herein. As such, various modifications or changes to or alternative configurations of the disclosed subject matter can be made in accordance with the teachings herein without departing from the spirit of the present specification. Lastly, the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to limit the scope of the present invention, which is defined solely by the claims. Accordingly, the present invention is not limited to that precisely as shown and described.

Certain embodiments of the present invention are described herein, including the best mode known to the inventors for carrying out the invention. Of course, variations on these described embodiments will become apparent to those of ordinary skill in the art upon reading the foregoing description. The inventor expects skilled artisans to employ such variations as appropriate, and the inventors intend for the present invention to be practiced otherwise than specifically described herein. Accordingly, this invention includes all modifications and equivalents of the subject matter recited in the claims appended hereto as permitted by applicable law. Moreover, any combination of the above-described embodiments in all possible variations thereof is encompassed by the invention unless otherwise indicated herein or otherwise clearly contradicted by context.

Groupings of alternative embodiments, elements, or steps of the present invention are not to be construed as limitations. Each group member may be referred to and claimed individually or in any combination with other group members disclosed herein. It is anticipated that one or more members of a group may be included in, or deleted from, a group for reasons of convenience and/or patentability. When any such inclusion or deletion occurs, the specification is deemed to contain the group as modified thus fulfilling the written description of all Markush groups used in the appended claims.

Unless otherwise indicated, all numbers expressing a characteristic, item, quantity, parameter, property, term, and so forth used in the present specification and claims are to be understood as being modified in all instances by the term “about.” As used herein, the term “about” means that the characteristic, item, quantity, parameter, property, or term so qualified encompasses a range of plus or minus ten percent above and below the value of the stated characteristic, item, quantity, parameter, property, or term. Accordingly, unless indicated to the contrary, the numerical parameters set forth in the specification and attached claims are approximations that may vary. At the very least, and not as an attempt to limit the application of the doctrine of equivalents to the scope of the claims, each numerical indication should at least be construed in light of the number of reported significant digits and by applying ordinary rounding techniques. Notwithstanding that the numerical ranges and values setting forth the broad scope of the invention are approximations, the numerical ranges and values set forth in the specific examples are reported as precisely as possible. Any numerical range or value, however, inherently contains certain errors necessarily resulting from the standard deviation found in their respective testing measurements. Recitation of numerical ranges of values herein is merely intended to serve as a shorthand method of referring individually to each separate numerical value falling within the range. Unless otherwise indicated herein, each individual value of a numerical range is incorporated into the present specification as if it were individually recited herein.

The terms “a,” “an,” “the” and similar referents used in the context of describing the present invention (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein is intended merely to better illuminate the present invention and does not pose a limitation on the scope of the invention otherwise claimed. No language in the present specification should be construed as indicating any non-claimed element essential to the practice of the invention.

Specific embodiments disclosed herein may be further limited in the claims using consisting of or consisting essentially of language. When used in the claims, whether as filed or added per amendment, the transition term “consisting of” excludes any element, step, or ingredient not specified in the claims. The transition term “consisting essentially of” limits the scope of a claim to the specified materials or steps and those that do not materially affect the basic and novel characteristic(s). Embodiments of the present invention so claimed are inherently or expressly described and enabled herein.

All patents, patent publications, and other publications referenced and identified in the present specification are individually and expressly incorporated herein by reference in their entirety for the purpose of describing and disclosing, for example, the compositions and methodologies described in such publications that might be used in connection with the present invention. These publications are provided solely for their disclosure prior to the filing date of the present application. Nothing in this regard should be construed as an admission that the inventors are not entitled to antedate such disclosure by virtue of prior invention or for any other reason. All statements as to the date or representation as to the contents of these documents is based on the information available to the applicants and does not constitute any admission as to the correctness of the dates or contents of these documents. 

1. A method of treating a Her2⁺ cancer in a patient in need thereof comprising administering a taxane and a RXR agonist of Formula I,

wherein R is H, or lower alkyl of 1 to 6 carbons, or a pharmaceutically-acceptable salt thereof, to the patient.
 2. The method of claim 1, wherein the patient had previously been treated with a taxane but not with the RXR agonist and had obtained less than a complete response.
 3. The method of claim 1, wherein the patient had previously been treated with the RXR agonist, but not the taxane.
 4. The method of claim 1, further comprising administering thyroid hormone.
 5. The method of claim 1, wherein the RXR agonist is the compound of Formula II:

.
 6. The method of claim 1, wherein the taxane is paclitaxel.
 7. The method of claim 1, wherein the taxane is docetaxel.
 8. The method of claim 1, wherein the Her2⁺ cancer is gastroesophageal cancer, ovarian cancer, stomach cancer, adenocarcinoma of the lung, uterine cancer, or salivary duct carcinoma.
 9. The method of claim 1, wherein the Her2⁺ cancer is breast cancer.
 10. The method of claim 1, the combination of the taxane and the RXR agonist has a growth inhibitory effect that is greater than the additive growth inhibitory effects of each of the two agents alone.
 11. The method of claim 1, further comprising administration of an additional anticancer agent.
 12. A method of treating a Her2⁺ cancer in a patient in need thereof comprising administering means for binding tubulin and inhibiting microtubule disassembly, means for blocking metaphase spindle formation, or means for inducing apoptosis by blocking Bcl-2-mediated inhibition of apoptosis and a RXR agonist of Formula I,

wherein R is H, or lower alkyl of 1 to 6 carbons, or a pharmaceutically-acceptable salt thereof, to the patient.
 13. The method of claim 12, further comprising administering thyroid hormone.
 14. The method of claim 12, wherein the RXR agonist is the compound of Formula II:

.
 15. The method of claim 12, wherein the taxane is paclitaxel.
 16. The method of claim 12, wherein the taxane is docetaxel.
 17. The method of claim 12, wherein the Her2⁺ cancer is gastroesophageal cancer, ovarian cancer, stomach cancer, adenocarcinoma of the lung, uterine cancer, or salivary duct carcinoma.
 18. The method of claim 12, wherein the Her2⁺ cancer is breast cancer.
 19. The method of claim 12, the combination of the taxane and RXR agonist has a growth inhibitory effect that is greater than the additive growth inhibitory effects of each of the two agents alone.
 20. The method of claim 12, further comprising administration of an additional anticancer agent.
 21. A method of treating a Her2⁺ cancer in a patient in need thereof comprising administering a taxane and means for activating RXR/Nurr1 heterodimeric receptors or rexinoid means for inhibiting tumor growth, to the patient.
 22. The method of claim 21, further comprising administering thyroid hormone.
 23. The method of claim 21, wherein the RXR agonist is the compound of Formula II:

.
 24. The method of claim 21, wherein the taxane is paclitaxel.
 25. The method of claim 21, wherein the taxane is docetaxel.
 26. The method of claim 21, wherein the Her2⁺ cancer is gastroesophageal cancer, ovarian cancer, stomach cancer, adenocarcinoma of the lung, uterine cancer, or salivary duct carcinoma.
 27. The method of claim 21, wherein the Her2⁺ cancer is breast cancer.
 28. The method of claim 21, the combination of the taxane and RXR agonist has a growth inhibitory effect that is greater than the additive growth inhibitory effects of each of the two agents alone.
 29. The method of claim 21, further comprising administration of an additional anticancer agent. 